Basic Information
| Provider Information | |||||||||
| NPI: | 1639285422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMOYA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 468 | ||||||||
| Address2: | |||||||||
| City: | SKOWHEGAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049760468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074747045 | ||||||||
| FaxNumber: | 2074746355 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 FAIRVIEW AVE | ||||||||
| Address2: | SUITE 223 | ||||||||
| City: | SKOWHEGAN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049761481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074747045 | ||||||||
| FaxNumber: | 2074746355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 06/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD17340 | ME | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD2005-0128 | NM | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 24310 | KY | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.